NEW YORK (AP) — This year, the germs roared back.
Measles tripled. Hepatitis A mushroomed. A rare but deadly mosquito-borne disease increased.
And that was just the United States.
Globally, there was an explosion of measles in many countries, an unrelenting Ebola outbreak in Africa and a surge in dengue fever in Asia. There were also backslides in some diseases, like polio, that the world was close to wiping out.
"It's been a tough year for infectious diseases," said Dr. Jonathan Mermin of the U.S. Centers for Disease Control and Prevention.
A look back at some U.S. disease trends in 2019:
There were nearly 1,300 cases of measles in the U.S. through November, That's the largest number in 27 years. There were no deaths but about 120 people ended up in the hospital.
This from a disease that vaccines had essentially purged from the country for a decade.
"How can we have gone from eliminating the disease to reviving a disease? It's mind-shattering that we would go in that direction," said U.S. Rep. Rosa DeLauro, D-Conn., who heads a congressional subcommittee that oversees public health spending.
Three-quarters of this year's cases were in Orthodox Jewish communities in or near New York City. As do most U.S. outbreaks, it started with travelers infected overseas who spread it to people who hadn't gotten a measles vaccine.
Vaccination rates in New York are good, overall. But it was a shock to learn how low they had dipped in some places, said Dr. Patricia Schnabel Ruppert, health commissioner in Rockland County, north of New York City. Distrust of vaccines had taken root in segments of the Orthodox community. The county took the unusual step of barring thousands of unvaccinated children from dozens of schools.
Hepatitis A tends to be thought of as a kind of food poisoning, often traced to an infected restaurant worker with poor hygiene. But the latest wave began in San Diego among homeless people and people who use illicit drugs. In 2017, there were 1,500 cases in four states tied to the outbreak. This year, it boomed to 17,000 in 30 states, with Florida and Tennessee the hardest hit.
Hepatitis A usually is not considered a fatal disease, but it can be for people whose livers are already damaged by hepatitis C or longtime drinking. Nearly 200 died this year.
A vaccine for hepatitis A is now included in routine childhood vaccines, but most adults are too old to have gotten it as children. Attempts to give the vaccine to vulnerable adults met resistance, said the CDC's Dr. Neil Gupta, who tracks the outbreaks.